Lessons from Mass Drug Administration for the
Elimination of Lymphatic Filariasis (LF) in an
Presentation
Abstract
Urban
Setting
in
Haiti
Number: 492
Number: 2900
Authors: Cudjoe Bennett1, Carl Fayette2,
Franck Monestime2, Alain Javel2, Lior Miller1,
Sarah Craciunoiu1, Abdel Direny⁴, Jean-Frantz
Lemoine3⁶
Author affiliations: 1IMA World Health,
Washington, D.C., USA; 2IMA World Health,
Port au Prince, Haiti; 3National Program to
Eliminate Lymphatic Filariasis, Ministry of
Public Health and Population, Port au Prince,
Haiti; 4RTI International
Background
The world is increasingly urbanized as 54%
of the world’s population lives in urban
areas, including 57% of the population in
Haiti. Urbanization has far-reaching health
consequences, as these highly mobile and
heterogeneous populations have varying
experiences and perceptions of the health
system. As lymphatic filariasis (LF) is endemic
throughout Haiti, the Haiti National Program
to Eliminate LF has a goal to eliminate LF as a
public health problem by 2020 through mass
drug administration (MDA) among other
activities. To achieve elimination, at least five
rounds of MDA with ≥ 65% coverage must
be completed for the population at risk.
High coverage rates are necessary for MDA
to be effective in reducing LF prevalence to
a level at which transmission is no longer
sustainable. Peri-urban settings in Haiti
typically require additional rounds of MDA.
Results
Table 1 displays the demographic characteristics of the survey respondents.
Table 1. Descriptive Statistics for Coverage Survey
Thomazeau
Croix-des-Bouquets
Total
Gender
Male, n (%)
424 (45.84)
520 (47.10)
944 (46.53)
Table 2. Reported MDA Coverage in Croix-desBouquets and Thomazeau, 2012-2015.
Commune
2012
2013
2014
2015
Croix-desBouquets
77.04%
*
70.04%
67.09%
Thomazeau
59.95%
*
91.76%
61.3%
*Note that due to funding constraints, MDA did not occur in these communes in 2013.
Female, n (%)
501 (54.16)
584 (52.90)
Total
925 (44.59)
1,104 (54.41)
Age, mean
(range)
25.82 (1-93)
26.3 (1-88)
1,085 (53.47)
2,029 (100)
The survey coverage for Croix-des-Bouquets was 53.3% compared to reported
coverage of 67.09%; 80% for Thomazeau (61.3% reported coverage). Historical
MDA coverage ranged from 67.09-77.04% in Croix-des-Bouquets and from 59.9591.76% in Thomazeau.
Figure 1. Reported MDA Coverage and Coverage Survey Results
Methods
Two communes were selected, the peri-urban
Croix-des-Bouquets and rural Thomazeau in the
West department, for a Knowledge, Attitudes
and Practice (KAP)/coverage survey. A twostage 30-cluster sample was used to ensure
random selection of smaller areas and to select
individuals randomly from these areas. Data
collection took 7 days and analyzed with STATA
version 14. Historical MDA data was used to
examine trends in MDA coverage over time and
to compare nationally-reported MDA coverage
with actual coverage from the survey.
Discussion
For both communes, reported coverage differed
significantly from actual coverage in 2015. In Thomazeau,
survey coverage (80.00%) was higher than reported
coverage (61.30%), whereas in Croix-des-Bouquets, the
opposite trend was observed, with actual coverage (55.30%)
being lower than reported coverage (67.09%). Two likely
reasons are, firstly, that accurate population denominator
figures are not available, since a national census has
not been carried out since 2003. Therefore population
denominators are estimated by applying a constant growth
percentage (3%) each year for each commune. Secondly
population estimates have varied significantly because
of high rates of population movement and displacement
following the 2010 earthquake. Reported coverage peaked
in 2014 in Thomazeau (91.76%) due to an increase in the
number of distribution posts, and declined in 2015 due to
significant security concerns in four localities and heavy
rains. Therefore programming decisions to assess and
improve coverage can only be made on the strength of
all of the data elements. The peri-urban nature of Croixdes-Bouquets may influence how and why respondents
participate in MDA. Croix-des-Bouquets is of interest as Haiti
nears LF elimination, since success relies on high coverage
urban MDAs. Additionally, general mistrust of the health
system and fatigue from participating in projects supported
by international aid may contribute to low coverage rates.
Operating in urban and peri-urban settings poses unique
challenges to health projects. Therefore there is a need to
employ different and innovative strategies in these settings
as compared to rural settings to achieve population
coverage.
Acknowledgements
This poster was prepared by IMA World Health with funding from the U.S. Agency for International
Development’s ENVISION project, led by RTI International under cooperative agreement no. AIDOAA-A-11-00048. The author’s views expressed in this publication do not necessarily reflect the views
of the United States Agency for International Development or the United States Government.